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Opinion: Youth mental-health services fall short

While the horrifying consequences of untreated mental illness played out from Vancouver to Moncton last week, a committee of MLAs spent a full day listening to people who work on the problem every day.

While the horrifying consequences of untreated mental illness played out from Vancouver to Moncton last week, a committee of MLAs spent a full day listening to people who work on the problem every day.

Politicians on the legislature’s child and youth committee decided to delve into one specific issue — youth mental health. They’re conducting a round of hearings and studies, and the June 11 session was devoted to hearing from doctors and caregivers.

There’s a general view that there are some gaps in the delivery system when it comes to caring for young people struggling with mental illness. But Dr. Steve Mathias, a Vancouver psychiatrist who works with adolescents through an outreach program, made the point more bluntly: “You could argue that it’s not actually a gap. It’s an absence of services.”

Mathias delivered a big-picture view of the situation. About 75 per cent of mental-health problems occur before age 25, and 80 per cent of substance abuse issues start before age 20.

Mental illness, ranging from anxiety to psychosis, accounts for about 60 per cent of the non-fatal burden of disease for people ages 15 to 34.

From that startlingly high share of the population, Mathias said only 20 per cent get access to treatment, and only two per cent will get specialist care.

Youth have limited access to GPs, and youth mental-health services are fractured “at the worst possible point of transition.”

There are services — to the tune of $78 million worth a year, just from the children’s ministry. But they’re fragmented. “Every door is the wrong door,” he said.

For those who work up the motivation to get treatment — which is a hurdle in itself — he equated it to a young person buying one of their first cars. They need a little sedan, but the only things available on the car lot are minivans.

“The family van meets different needs. It’s a different vehicle. And that’s what adult mental-health services are. They’re designed for chronically ill individuals — average age of 40 to 45 — and we’re asking young people to access adult mental-health services when they graduate from child services.”

The government is well aware of the shortfalls, and the issue has been getting some attention. But Mathias questioned the priorities that have been set, saying the early-years service that got some attention hasn’t been shown to make a meaningful difference.

Meanwhile, the cohort from 17 to 25 years of age could use a lot more targeted help.

“So where do they go? Look no further than the emergency room. That’s where they show up,” said Mathias.

He said youth admittance to ERs has almost tripled in five years, but they aren’t the right place.

The program he runs evolved after the discovery that hundreds of young people with mental-health issues were being discharged from ERs without any followup. For the last few years, a team has been chasing them down and helping them as best they can.

“We struggle, because it’s so overwhelming.” (The outreach office had five new renewals by noon one day last week.)

His pitch was one of dozens the committee will hear over the next few months. Devote $100 million, a half per cent of the health budget, to youth mental health. Focus it on 12- to 15-year-olds. Open 15 integrated health centres for youth across B.C. More psychiatrists, and more tele-psychiatry for rural areas.

They would include clinics for intensive case management, and emphasis on reintegrating kids back into the community, not transitioning them to adult care.

He said the commitment to such work is growing in B.C. communities, and a financial commitment from the government would further the progress.

“We just have no services for these guys … We’ve got no model for it, which is kind of nice, actually, because that means you can do anything. You can just start fresh and do something right.”

MLAs are accepting submissions from the public until July 25.

Details are on the committee page of the legislature website: